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Cough away, but don’t treat a sore throat

When you cough up phlegm in yucky shades of yellow and green, you need to take antibiotics, right? Wrong. Acute cough, with or without phlegm, in otherwise healthy adults does not need antibiotic treatment.

india Updated: Mar 28, 2011 17:59 IST
Sanchita Sharma

When you cough up phlegm in yucky shades of yellow and green, you need to take antibiotics, right? Wrong. Acute cough, with or without phlegm, in otherwise healthy adults does not need antibiotic treatment as the drugs do little to cure or lower symptoms, shows new research.

Phlegmy cough, however bad, is the newest disorder being added to the list of diseases that do not need antibiotics, which just kills bacteria, not viruses. The study, published in the European Respiratory Journal on Friday, used data of 3,402 adults with acute cough from 14 centres across Europe.

Almost 95 per cent of all colds, flu and bronchitis are caused by viral or low-acuity bacterial infection that gets over on their own and does not need antibiotics.

Even in cases of acute bronchitis, antibiotics are almost never needed because the infection is usually viral. In still other cases, like acute sinusitis and sore throats, antibiotics help a small percentage, depending on the infecting microbe and the duration of the dose. A 10-day course of penicillin works against strep throat but if the course is limited to three or five days, the infection recurs.

A red and sore throat along with swollen lymph glands and fever are signs of strep infection. There is almost always no cough or nasal congestion.

Yet penicillin and other broad-spectrum antibiotics are routinely prescribed for acute bronchitis, earaches, clogged sinuses, sore throats and colds, creating drug-resistant or “superbug” strains of bacteria. Drug-resistance happens when a weak or an incomplete dose of antibiotics knocks the bacteria down but does not kill it, causing it to mutate and emerge stronger.

The more frequently and broadly an antibiotic is used, the more likely it is that microbes will develop ways to sidestep it. Rationalising use helps contain the problem, as in the Netherlands, where selective use of antibiotics has resulted in fewer superbug infections as compared to the US and the UK.

People infected with superbugs have longer and more expensive hospital stays, and are more likely to die of the infection. New Delhi metallo-beta-lactamase (NDM-1), for example, which shot to fame last year with a study in The Lancet tracing its origin to the subcontinent, is a newly identified enzyme conveying bacterial resistance to all standard intravenous antibiotics used to treat severe infections.

The enzyme makes it resistant to all existing antibiotics, including carbapenem, which is used to treat other superbugs such as methicillin-resistant Staphyloccus aureus (MRSA). Since superbugs such as NDM-1 and MRSA are difficult to treat, the infection spreads easily within the body, especially people who are ill or recuperating from an illness.

The arsenal of antibiotics strong enough to kill emerging drug-resistant strains is rapidly dwindling, with no new drugs emerging. Three new classes of antibiotics have come up in the past two years — cyclic lipopeptides such as daptomycin, glycylcyclines such as tigecycline, and oxazolidinones such as linezolid — but these are expensive and used sparingly as a last resort to save lives.

Death apart, superbugs are causing reemergence of diseases controlled for decades in the West. Every year, nearly 500,000 new cases of multi-drug resistant tuberculosis (MDR-TB) occur worldwide, of which more than 99,000 are in India. Globally, less than 7 per cent of 440,000 new MDR-TB cases each year receive treatment simply because it takes longer and costs more: Rs 1 lakh per patient to treat over two years, as compared to Rs 600-Rs 800 needed for standard treatment over in six months.